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August 21, 2008
FULL TABLE OF CONTENTS	\|	THIS WEEK IN THE JOURNAL	\|		AUDIO SUMMARY

ELECTION 2008
Health of the Nation
In the 2008 Shattuck Lecture, 13 distinguished panelists address the need for universal health coverage in the United States, pressing challenges to the U.S. health care system, and possible solutions, in a seminar moderated by law professor Arthur Miller. Watch the video, vote, and add your comments. Read Excerpts Read Related Editorial

The Partisan Divide — The McCain and Obama Plans for U.S. Health Care Reform
There is broad agreement that the U.S. health care system requires reform. Jonathan Oberlander writes that Democrats and Republicans remain sharply divided over how to reform it.
Free Full Text

Variants of SLCO1B1 Associated with Statin-Induced Myopathy
A genomewide screen of patients with myopathy who were taking high-dose simvastatin showed a strong association between myopathy and variants of SLCO1B1, which encodes an organic anion–transporting polypeptide. CME Exam

Published Online July 23, 2008 (DOI: 10.1056/NEJMoa0801936)

Preeclampsia and the Risk of Later End-Stage Renal Disease
By linking data from national medical registries in Norway, the investigators showed that women with a history of preeclampsia were at higher risk for subsequent end-stage renal disease than were women with a history of uncomplicated pregnancy.

Adalimumab in Juvenile Rheumatoid Arthritis
In children with polyarticular juvenile rheumatoid arthritis who had a response to a 16-week course of treatment with adalimumab, a monoclonal antibody to tumor necrosis factor, disease flares were less common when adalimumab was continued than when it was withdrawn.

Health and Economic Implications of HPV Vaccination in the United States
The authors conducted a cost-effectiveness analysis of human papillomavirus (HPV) vaccination in the United States and estimated that vaccinating 12-year-old girls would cost $43,600 per quality-adjusted life-year gained. If vaccine-induced immunity wanes after 10 years, HPV vaccination would be much less cost-effective. Free Full Text CME Exam

Idiopathic Sudden Sensorineural Hearing Loss
A healthy 58-year-old woman answers the telephone and realizes that her hearing is diminished on the left side. She notices aural fullness and loud tinnitus in the affected ear. How should she be evaluated and treated? CME Exam

Listen to the full text of this article.

A Woman with Headache and Behavioral Changes
A 26-year-old woman was admitted to the hospital because of headache, behavioral changes, abnormal movements, and inability to communicate. Imaging studies showed an ovarian mass consistent with a dermoid cyst.

Talking Dirty — The Politics of Clean Water and Sanitation
The lack of access to clean water and basic sanitation represents a silent crisis affecting more than a third of the world’s population. Drs. Michele Barry and James Hughes write that this seems an appropriate time to reengage in an ancient conversation about safe water and sanitation. (View slide presentation.) Free Full Text

Editorials
Health of the Nation — Coverage for All Americans Free Full Text

Pharmacogenomics and Drug Toxicity
Published Online July 23, 2008 (DOI: 10.1056/NEJMe0805136)

Preeclampsia — A Glimpse into the Future?

Human Papillomavirus Vaccination — Reasons for Caution Free Full Text